Risk of peripheral artery disease according to race and sex: The Atherosclerosis Risk in Communities (ARIC) study. (May 2021)

• Record Type: Journal Article
• Authors: Hicks, Caitlin W.; Ding, Ning; Kwak, Lucia; Ballew, Shoshana H.; Kalbaugh, Corey A.; Folsom, Aaron R.; Heiss, Gerardo; Coresh, Josef; Black, James H.; Selvin, Elizabeth; Matsushita, Kunihiro
• Is Part Of: Atherosclerosis. Volume 324(2021)
• Page Start: 52
• Page End: 57
• Publication Date: 2021-05
• Subjects: Peripheral artery disease -- Critical limb ischemia -- Race -- Ethnicity -- Disparities -- Risk; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.03.031
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Previous community-based studies have demonstrated sex and race-based disparities in the risk of cardiovascular disease. We sought to examine the association of sex and race with incident peripheral artery disease (PAD-) and critical limb ischemia (CLI-) related hospitalizations. Methods: In 13, 451 Black and White ARIC participants without prevalent PAD at baseline (1987–89), we estimated the cumulative incidence of PAD- and CLI-related hospitalization over a median follow-up of 26 years. We quantified hazard ratios (HRs) using Cox models across four sex- and race-groups. PAD and CLI were defined by hospitalization discharge codes. Results: The cumulative incidence of PAD-related hospitalization was higher in males than females in Whites (5.1% vs. 2.7%; p< 0.001) but not in Blacks (5.7% vs. 5.0%; p= 0.39). The cumulative incidence of CLI-related hospitalization differed significantly by race more than sex, occurring in 3.1% Black males, 3.1% Black females, 1.4% White males, and 0.8% White females ( p< 0.001). After risk factor adjustment, the risk of incident PAD-related hospitalization was similar for White males vs. White females [HR 1.14, 95%CI 0.90–1.45], and slightly higher for Black males [HR 1.26, 95%CI 0.92–1.72] and Black females [HR 1.39, 95%CI 1.03–1.87] compared to White females. The adjusted risk of incident CLI-related hospitalization was similar for White males vs. White females [HR 1.15, 95%CI 0.75–1.76], and significantly higher for Black males [HR 1.96, 95%CI 1.22–3.16] and Black females [HR 2.06, 95%CI 1.31–3.24] compared to White females. Conclusions: These data suggest that there are both sex- and race-specific patterns of PAD-related hospitalization that lead to differences in clinical disease risk and presentation. Graphical abstract: Image 1 Highlights: Males have a higher risk of incident clinical peripheral artery disease (PAD) than females in Whites, but not in Blacks. The risk of incident CLI differs significantly by race more than sex. The elevated risk of incident critical limb ischemia (CLI) was similar between Black males and females. There are both sex- and race-specific patterns of PAD.